In a scathing critique of health care coverage by America’s news media, the current issue of the Columbia Journalism Review contends that “this year’s health-care debate sounds like the one in 1993.” That debate produced the Clinton administration’s proposed reforms that were politically dead on arrival.

“With few exceptions … the press has done little to challenge this reality or help to broaden the health-care debate,” wrote Trudy Lieberman, a Columbia Journalism Review contributing editor who monitors this issue. “Rather, it has mostly passed along the pronouncements of politicians and the major stakeholders who have the most to lose from wholesale reform. By not challenging the status quo, the press has so far foreclosed a vibrant discussion of the full range of options, and also has not dug deeply into the few that are being discussed, thereby leaving citizens largely uninformed about an issue that will affect us all.”

As Congress winds down its latest try at reforming America’s hodge-podge health system, eying the exits for a long vacation, there’s been no real debate, for instance, over a bill in the hopper that would create a single-payer plan.

A Democratic Congressman from New York, Anthony Weiner, raised this issue last week to deafening silence in the national news media, which was all agog over the latest distractions to comprehensive reporting of what‘s happening on the medical-bills battlefront. Weiner is a cosponsor of the U.S. National Health Care Act (H.R. 676), sponsored by Rep. John Conyers (D-Mich.). This bill has 85 co-sponsors and is backed by a coalition of doctors, unions, civic groups and local governments in support of a single-payer system.

“Without acknowledging it, both sides seem to agree with the argument for a single-payer system. But instead of having a debate about its value, both sides have turned the idea into an odd punching bag,” Weiner said. “The right uses the term ‘single-payer’ to condemn the White House approach, while the White House — and my colleagues in the House and Senate — quickly decry the scurrilous charge and concoct legislative language to make their public option look less, well, public. By conceding that the public option would have less overhead, be more efficient and have the freedom to focus on health care rather than profits, opponents of the public option are in fact arguing for it. Isn’t complaining about the marketplace ‘advantage’ of the public plan just another way of saying that people are going to want it?”

Dr. Quentin Young, national coordinator of Physicians for a National Health Program, lauded Weiner’s stance and lambasted the reform plan cobbled together by House leaders as a “proven failure.” Young argued, in a news release on behalf of his group of 16,000 doctors, that “state-based reforms of this type — Massachusetts being the latest example — have repeatedly foundered.”

“Although many supporters of the House tri-committee bill are well-intentioned, it’s an inconvenient truth that only by replacing the private health insurance industry with a single-payer, Medicare-for-All program can we save $400 billion annually on overhead and bureaucracy – enough to provide comprehensive, first-dollar coverage to all,” Young added. “Surveys show that two-thirds of the public favor national health insurance, as do most physicians. Over 550 labor organizations support H.R. 676, as do scores of civic and religious groups and city governments.”

The $400 billion savings that Young referred to would come from eliminating the administrative overhead in private insurance plans, which eat up 30 per cent of their billings, in contrast to Medicare’s administrative costs of 3 to 4 percent, freelance journalist Dave Lindorff recently noted on his website.

“So, want to have some fun? Tell your congressional delegation to demand that the Congressional Budget Office, which just came up with an estimate that the Senate’s health ‘reform’ bill would add $1.6 trillion in costs over 10 years, do a study of what expanding Medicare to all would cost, after netting out the savings to individuals and employers of having their insurance payments and out-of-pocket health expenses eliminated,” Lindorff wrote in an op-ed piece that’s been popping up in various corners of the blogosphere. “And then tell them to support Michigan Congressman Rep. John Conyers’ single-payer bill, HR 676, which would extend Medicare to one and all.”

That bill is not even on the radar screen in the Senate, where leaders of the finance committee are crafting a minimalist reform measure that excludes any hint of extending Medicare to more citizens. “After weeks of secretive talks, a bipartisan group in the Senate edged closer Monday to a health care compromise that omits a requirement for businesses to offer coverage to their workers and lacks a government insurance option that President Barack Obama favors, according to numerous officials,” The Associated Press reported today. “They said any legislation that emerges from the talks is expected to provide for a non-profit cooperative to sell insurance in competition with private industry, rather than giving the federal government a role in the marketplace. The White House and numerous Democrats in Congress have called for a government option to provide competition to private companies and hold down costs.”

While Congress takes off on vacation in August, maybe its members will start paying attention to what local folks have to say about the health-billing mess. Consider what this emergency room doctor in Michigan argued today in the Detroit Free Press website:

“In order to maintain their profit margins, insurance companies are raising premiums while pushing more of the costs of care onto individual policyholders. Premiums are increasing annually at a rate that is three times the rate of inflation. Fewer employers, especially small firms, continue to offer comprehensive coverage, and for workers with employer-based insurance, out-of-pocket expenses increased 34% between 2004 and 2007. Those who have been laid off are finding that extension coverage under COBRA is overpriced and unaffordable,” noted Dr. James Mitchiner of Ann Arbor.

“But there is a viable alternative,” Mitchiner added. “Single-payer health insurance is simply a way to finance universal health care. By replacing the 1,200 private insurance companies — each having its own set of regulations, provider networks, prescription drug formulary, pre-authorization forms, 1-800 number and Web site — into a single insurance entity, such a single-payer system would reap the benefits of economies of scale, reduce administrative waste, mitigate bureaucratic duplication, sever the link between health insurance and employment, reduce health care disparities, and at last provide creditable coverage for the millions who lack it now.”

4 Responses to “Health Bills Debate”

In other words, the good congressman (and the others) wants to create a monopoly on health insurance. Monopolies, as I’m certain you are aware, are notoriously inefficient. The proof is in the pudding – look no further than the wait times in Canada.

One problem is that people in general, including Brooks, talk about “the plan.” Which plan would that be? There are several in the works, all in Congress, as they go about their busy business. All of this is so complicated, convoluted, and just plain voluminous that no one really understands all of it, including the President himself. We’re way short, maybe years short, of having a real health care reform plan in hand that citizens can read and understand and responsible members of Congress should actually vote for. The pressure to “get ‘er done” by the end of the year is sheer politics, nothing more.

I don’t have to be convinced that costs have to be reduced and health insurance of some kind should be available to all. I’m just not convinced that what’s going on now is going to accomplish those fairly simple goals.

I’m always suspicious when someone says the government can administer something — anything — more efficiently than anyone else. When you consider the size and complexity of the U.S. health care system, to think that the federal government as single payer can manage it better that it is now just strains credibility.

One more thing — why is tort reform completely off the table and stuffed in a dark closet somewhere? This is a factor of some importance in the rising cost of health care, but the fact is trial lawyers (just like the NRA) so heavily grease the palms of politicians that they won’t go against them.

So far, health care reform isn’t about less expensive and universal health care; it’s about politics as usual.

Jan, part of the reason you wait so long in emergency rooms is that too many people use the ER as their primary care physician. If your case is not emergent or urgent, you are going to wait unless there’s nobody else in line. Many people know how to play the ER, too. If you come in claiming chest pain, you are going to the front of the line, end of story. You will get (at the very least) a chest x-ray, an EKG reading, several blood tests, etc, etc.

Many ERs have a nurse:patient ratio of 1:8 or 1:10, some even higher, and that’s at Level 1 trauma centers (the highest rating). A Level 1 trauma center is rated to handle any physiological crisis (neuro, cardio, respiratory, etc). I don’t know what the doc:patient ratios are, but if the nurses are having to carry a load that high, you can bet that it’s even worse for the doctors.

ER docs don’t want to be sued, so in many cases, they order every test imaginable for a reported condition. Your month wait for your knee is likely due to a shortage of orthopedists. FWIW, it takes 5 years upon graduation from med school to be able to practice orthopedics. Residency programs in orthopedics are kind of selective about med school candidates they hire. They have to compete with the other highly sought-after specialties – surgery, plastic surgery, dermatology, ophthalmology….

You cannot graduate at or near the bottom of your med program and expect to get one of those residencies.

Nationalizing health care will not change any of that, except to make it worse. How many people, in their right mind, are going to take the responsibility of those positions for the kind of remuneration they might expect from the federal government? Under a nationalized plan, you can expect that we’ll be inundated with internists, pediatricians, and family practice doctors, and not much else. What internist, under such a system, is going to work his guts out to sub-specialize in cardiology, pulmonology, neurology, endocrinology, or a host of others that require an additional two year fellowship after completion of a residency before the physician can practice this sub-specialty?

How many of our best and brightest are even going to choose careers in medicine when careers in engineering and programming will be just as challenging and lucrative and without all of the headaches associated with the nightmare that nationalized health care will undoubtedly be?

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